View Information Collection (IC)

View Information Collection (IC)

Attachment C – Social and Health Experiences Self-Administered Questionnaire
No New

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment C Attachment C Attachment C. SDOH SAQ_paper draft 4_to AHRQ.docx Yes Yes Fillable Fileable

Health Health Care Services


27,059 0
Individuals or Households
   90 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 27,059 0 27,059 0 0 0
Annual IC Time Burden (Hours) 3,157 0 3,157 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D – 60 Day FRN 60 Day FRN.pdf 07/29/2020
Attachment E – Public Comments: Academy of Nutrition and Dietetics Attachment E Academy of Nutrition and Dietetics_MEPS Social and Health Experiences SAQ.pdf 07/29/2020
Attachment E1 – AHRQ Response to Academy of Nutrition and Dietetics Attachment E1 AHRQ Response to AND.msg 07/29/2020
Attachment F – Public Comments: Brookings Attachment F Brookings AHRQ survey comments May 2020 - Graham.docx 07/29/2020
Attachment F1 - AHRQ Response to Brookings Attachment F1 AHRQ response to Brookings Letter.docx 07/29/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.